There weren’t many silver linings to the pandemic, but the rise of telehealth was one of them. Patients across the country learned firsthand that they could often get the medical care they needed without having to go in person to a doctor’s office and risk being exposed to a bunch of sick people in the waiting room. Health systems were able to reduce hospital overcrowding and reach patients in remote settings experiencing provider shortages. At the onset of Covid, lawmakers and regulators from both parties and all levels of government saw the need to make telehealth far more accessible, and acted quickly and decisively to make it possible for doctors to treat across state lines and to expand insurance coverage for digital visits. But after Covid showed signs of receding, states began limiting patient access to telehealth again. Twenty-five states have already terminated the emergency declarations introduced during Covid to waive licensing requirements for doctors treating out of state patients. Making it harder for patients to see their doctors, and for doctors to see their patients, isn’t good for either of them. The technology exists to bring people together regardless of where they live or work. In what logical world would we take that away? My venture capital fund, Tusk Venture Partners, is heavily invested in the digital health space, helping fund and accelerate companies like Ro, Wheel, Alma, Boulder Care, Radish Health, Get Labs, and others. We invested in the sector because we believe that when there’s demand for a product or service—in this case, patients being able to see doctors, as needed—and there’s no additional material cost or harm in doing so, market demand ultimately wins out over regulatory intransigence. Yes, medical boards want to retain the ability to discipline doctors who violate their codes of conduct when treating patients in their state. And arguably, doctors in more expensive states like New York and California could have a hard time competing with doctors in lower cost-of-living states. But our problem is not an oversupply of medical professionals. It’s actually the opposite. We need more doctors to treat more patients. The simplest answer to the problem is to expand medical licensing. Doctors would receive a medical license in their state of residency, but as with a drivers license, it would apply everywhere. The Veterans Administration already does this with its doctors. And nurses already have the option for a multistate license, with 38 states participating in a national network to help make nursing services more accessible. Every patient who started seeing out-of-state doctors during the pandemic should be allowed to continue to do so. Denying access at this point is not only cruel, but it doesn’t lead to the best healthcare outcomes. The pandemic should have been just the kicking off point for digital health. There is a big opportunity to decentralize the healthcare system: to reduce our reliance on hospitals that require massive capital and have massive operating expenditures, address provider shortages and expand access to specialists, and allow patients to see the healthcare system as a convenient, customer-focused sector. That’s why regulators need to go further. We need a framework that recognizes that patients should not be limited to provider options within state lines and be allowed to leverage the opportunities telehealth presents: let doctors connect to patients needing care, regardless of their physical location. If a doctor is licensed and has a clean disciplinary record, they should be able to treat patients anywhere, all of the time. If a complaint is filed against a doctor, and a medical board validates the complaint, then the doctor should lose out-of-state privileges, in addition to having to deal with the medical board in their own state. But to deny care to millions of people just to protect against rare edge cases in which a doctor could misbehave is bureaucratic logic at its apex. The 25 states that have rolled back access to out-of-state doctors should restore the practice immediately. In fact, federal grants to state Medicaid programs could even be conditioned on providing maximum opportunity for patients to get the care they need, just like how federal highway funds are distributed on the condition that states maintain a legal drinking age of 21. Covid was a genuinely awful experience. We don’t even have an inkling yet of all of the costs, all of the harm, all of the setbacks caused by living in quarantine, kids attending remote school, the economy being shutdown, and everything else. But the emergence of digital health was a rare bright spot in a sea of despair and frustration. We should try to make the most of that.
Bradley Tusk is a venture capitalist, writer, philanthropist, and political strategist.
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